Private health care, cancer, and the vulnerable middle class in Kenya

Abstract

A novel terrain of health care is emerging in Kenya at the intersection of a cancer epidemic, expanding medical and health insurance markets, the continued evisceration of public health care, and a middle class that can raise funds from credit, loans, and social networks. As middle-class cancer patients and their families navigate these landscapes, they find themselves vulnerable both to the “ordinary crisis” of public health care undermined by austerity and neglect, and to an extractive medical marketplace offering state-of-the-art treatment that is just within, or just beyond, financial reach. To analyze this, I build on Lauren Berlant's concept of cruel optimism, which captures how precarity is not only grounded in economic realities but also tied to hopes and expectations that always remain unfulfilled, creating constant anxiety and exhaustion. Further, I examine the double binds of cancer treatment and the entanglements between medical, health, and economic precarities, as families are drawn into private health care while the state disinvests in public services.